TYPHUS FEVER, TRENCH FEVER, ETC. 947 



seemed to arise almost entirely from the front areas was spoken of 

 as Trench fever. 



The Disease. Work on the clinical differentiation of the disease 

 was done by a great many army surgeons. An accurate report was 

 made by McNec, Brunt and Renshaw, ;i5 by a number of German 

 workers, and finally by a British and by an American commission, 

 the American group organized under Strong, and including as 

 clinician Homer Swift. In a Harvey Lecture by Swift 36 printed in 

 the Archives of Internal Medicine, July, 1920, an accurate summary 

 of available facts concerning this disease to date may be found. 



The disease is sudden in onset with fever, headache and pains 

 in the muscles. The onset resembles that of influenza. In a few 

 days, pain and tenderness of the joints appears, and the temperature 

 shows peculiar remissions which Swift characterizes as being of the 

 " spiky" type. 



Characteristic of the disease are the bone pains which are not 

 accompanied by any signs of inflammation. There may be continued 

 hyperesthesia. There may be sensory disturbances with increase of 

 the tendon reflexes. The fever curves are very irregular, some show- 

 ing the intermittent "spiky" type referred to above, others develop- 

 ing the typhoid-like ladder type. Another characteristic is the 

 frequency of relapses, in which, after remissions of varying intervals, 

 a second rise of temperature comes on. The relapses may come on 

 after weeks or months. A case of which we have personal knowledge 

 has developed two relapses in the course of two years after the 

 original attack. In other cases Swift states that the manifestations 

 may assume a subacute or chronic form with low grade fever which 

 may continue for months. 



Transmission and Etiology. McNee, Brunt and Renshaw, in 

 1916, succeeded in transferring the disease from man to man by 

 intravenous and intramuscular injections of whole blood. In these 

 early experiments they found that the plasma if entirely free from 

 hemoglobin, was not infectious, but that the red cells contained the 

 virus even after repeated washings. They did not succeed in passing 

 the virus through a Berkefeld filter. In 1917, Werner, whom we 

 quote from Swift, allowed' himself to be bitten by lice that had 

 previously fed on trench fever patients, and is said to have con- 



K McNee, Brunt and Kenshaw, Brit. Med. Jour., 1, 1916, 295. 

 "Swift, Harvey Lecture, Harvey Soc., New York, Jan. 10, 1920. 



